Scaling-Up Community-Based Counseling and Distribution of DMPA-SC in the DRC
USAID’s Evidence to Action (E2A) Project’s community-based family planning project, implemented from 2014–2020, aimed to increase access to family planning (FP) to those who need it most in rural, hard-to-reach areas of Democratic Republic of the Congo (DRC). By de-medicalizing and decentralizing FP service delivery through trained, non-clinical community health workers, E2A was able to provide more women with more methods, including depot medroxyprogesterone acetate (DMPA-SC), which is administered subcutaneously. The World Health Organization describes self-injectable DMPA-SC as a safe and effective family planning method, and studies in Malawi demonstrated improved DMPA continuation among women who self-inject, compared with women who received the injection by a trained provider. As the COVID-19 pandemic highlights gaps in access to and availability of services within the health system, the ability for women to choose and access FP counseling and methods in their own communities is more important than ever. E2A’s results suggest that community-based distributors provide the opportunity to further task-shift DMPA-SC to the FP user herself—an important step on the road to universal self-injection and self-care, which increases women’s ability to select and eventually administer their chosen FP method.